The majority of clinicians who draft practice guidelines for hyperlipidemia and diabetes have conflicts of interest, researchers found.

Action Points

Explain that the majority of clinicians who draft practice guidelines for hyperlipidemia and diabetes have conflicts of interest.

Point out that among the 73 panelists who formally declared having no conflicts, Neuman and colleagues found that 11% of them did indeed have at least one financial relationship.

The majority of clinicians who draft practice guidelines for hyperlipidemia and diabetes have conflicts of interest, researchers found.

In a review, 52% of doctors on guideline-writing committees had financial conflicts of interest, some of which had gone undeclared, Jennifer Neuman, MD, of Mount Sinai School of Medicine in New York City, and colleagues reported online in BMJ.

"Our data illustrate the pervasiveness of conflicts of interest among members of guideline panels and may raise questions about the independence and objectivity of the guideline development process," they wrote.

There's been much attention focused on conflicts of interest between clinicians and pharmaceutical or device companies, and such relationships may be of particular concern in the development of widely disseminated clinical practice guidelines, Neuman and colleagues said.

The Institute of Medicine recently recommended that guideline panels should be as conflict-free as possible, they pointed out.

To determine the prevalence of financial conflicts of interest among panelists charged with producing clinical practice guidelines on screening and treatment for hyperlipidemia or diabetes, Neuman and colleagues reviewed a total of 14 guidelines from the U.S. and Canada, released between 2000 and 2010.

Five of those guidelines had no declaration of conflicts of interest at all, they reported.

There were a total of 288 panel members -- representing 265 different clinicians -- participating in drafting the reviewed guidelines.

The researchers found that 48% of the total panelists reported having conflicts of interest, while 52% said they either had none or didn't have an opportunity to declare any.

Among the 73 panelists who formally declared having no conflicts, Neuman and colleagues found that 11% of them did indeed have at least one financial relationship.

Of the 77 panelists who said they had no opportunity to declare conflicts, 5% actually had financial relationships, the researchers reported.

Overall, 150 guideline authors, or 52% of the total sample, had conflicts of interest, 138 of which were declared and 12 of which were undeclared, they wrote.

Neuman and colleagues noted that four of the panelists with those undeclared conflicts had no opportunity to declare them.

They also found that panel members of government-sponsored guidelines were less likely to have conflicts of interest than those sponsored by nongovernment sources (16% versus 69%, P<0.001).

That finding remained significant in sensitivity analyses that were limited to guidelines in which panelists had the opportunity to declare conflicts, they said (46% versus 72%, P=0.01).

The researchers noted that their search found only three members of U.S. Preventive Services Task Force and Veterans Affairs guideline panels had undeclared conflicts, "suggesting that conflicts of interest are managed well on government-sponsored panels."

They concluded that organizations that produce clinical practice guidelines should minimize financial conflicts among their panelists in order to "ensure the credibility and evidence-based nature of the guidelines' content."

The study was limited because it counted some conflicts twice, but the researchers noted that even without double counting, the rate of conflicts would still be 50%, which wouldn't change the implications of the findings.

The study may also have been limited in generalizability given that the sample was limited to only two disease conditions.

In an accompanying editorial, Edwin Gale, MD, of Southmead Hospital in Bristol, England, wrote that the diabetes and hyperlipidemia markets accounted for sales of nearly $71 billion in 2010. Clinical practice guidelines can assist marketing strategies.

"With billions of dollars at stake, a company has every motive to encourage potential guideline panelists to view its product in a favorable light, and a virtually limitless budget to support this objective," Gale wrote.

He also noted that while more guideline committees have reported disclosures over time, the proportion of members who have them has not changed. However, he noted that it requires a "charming sense of unreality" to suggest banning conflicted members from writing guidelines.

"What is needed is a change of culture in which serving two masters becomes as socially unacceptable as smoking a cigarette," Gale wrote. "Until then, the drug industry will continue to model its behavior on that of its consumers, and we will continue to get the drug industry we deserve."

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